Dr. Ndidiya Maka Amutah-Onukagha
Appearances
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
make sure that we have providers that come from these communities and backgrounds as well. I think that's a very, very important part of the conversation. So if we have universal healthcare, who is providing the healthcare? What do they look like? What's their background? What's their ideology around labor and delivery and birth?
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And how do they prioritize patients of color, people from underserved backgrounds, et cetera? It's both. Yes, universal healthcare is a card to play in this conversation and also diversifying the healthcare workforce is huge to me.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Medicaid plays a huge role. The type of insurance you have really dictates the quality of care you're going to be able to get, how long it takes to get into the care. Can you see a specialist? Do you get the bells and whistles? Do you get a nutritionist? Do you get a lactation consultant coming to your house? Do you get sent home from the hospital with a remote blood pressure monitoring kit?
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
If you have good private insurance, these are the things that you should have. Even if you have pretty decent public insurance, these are some of the things you should have. Medicaid has a huge role to play because they cover so many births. And there is a current model on the street. CMS just released something called TEMA, Transforming Maternal Health.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
It's a 10-year project that is funding 15 states to reimagine, redevelop, revamp their maternal health, clinical care, and Medicaid policies. It's an incredible initiative and commitment. It's just starting now. So we don't have a lot of data, but I am excited to see this type of commitment. I really hope that we're able to see it through for the 10-year duration as it was slated to be.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I hope that we're able to actually launch it and get it off the ground and that it actually has the resources and personnel to be meaningful because that's how it was conceptualized.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
The maternal health care deserts are significantly having impact on U.S. families and also health care systems. When we see spaces that are maternal health deserts, they really are limiting access to essential prenatal delivery and postpartum care. These are really pronounced in rural areas, like you just mentioned, or underserved communities. in Texas and other parts of the country.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And these maternal health care deserts are in areas where there is a lack of maternity care services, including hospitals with obstetric care, OB-GYN certified nurse midwives. These deserts are why we need more birthing centers.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
These hospital closures, OB unit closures, exacerbated by the pandemic, etc., are causing tremendous shortages and causing people to look to other birthing options to be able to have safe and joyful birthing experiences. As maternity care does, it's continuing to grow across the country. We're seeing real changes in how people experience their pregnancy and child birthing journeys.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Fewer hospitals are offering maternity services. Families are turning to new and alternative ways to get the care that they need and, frankly, that they deserve. One of the biggest shifts that we've seen is the increased use of telehealth services. So there's nothing that's going to replace the quality of in-person care when it's truly needed.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
But virtual options like online birthing classes, prenatal consultations, postpartum mental health support, they're really helping to bridge this gap. And for many people, these services can mean all the difference between getting help or going without. We're also seeing a rise in mobile maternity clinics.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Programs like March of Dimes, Better Starts are bringing prenatal care directly to families in places like Washington, D.C. and Ohio, places where traditional service models may no longer exist in certain parts of those places. And it's also an important step towards making care more accessible. We're also seeing the opening of birth centers.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We're doing a lot of advocacy around that here in Massachusetts, really trying to be very clear with our legislators about why we need more birthing centers in the state. We only have one open birthing center right now. I'm actually on the board of another one that we're trying to get our doors open called Neighborhood Birth Center here in Boston that's fighting an uphill battle.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
These birthing centers are a ship. They offer a more personalized, midwifery-led approach that many families find comforting, empowering, and reassuring.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Some of the work that we're doing here at the center is tied through advocacy and being a huge proponent and a huge part of why we got the Massachusetts Maternal Health Mom Bus passed in August 2024, which is helping to peel back some of our very outdated regulations, which is going to make it easier to both build and operate birth centers here in the Massachusetts Commonwealth.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We're also seeing greater access to doulas in certain parts of the country, more lactation consultants, more community health workers who are really here to support pregnancy, labor, and postpartum recovery. I think in places like Arizona, for instance, there's a program that's helping make sure that people are tackling transportation barriers.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So they're helping people get safely to their appointments. In my hometown of Trenton, New Jersey, they're breaking ground on a birthing center program Trent is a very high need urban community with very high severe maternal morbidity and maternal mortality and putting a lot of resources and money and advocacy behind it. This is what we need.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
This is how you focus on community-based solutions and meet people at their place of need. And we know that People are seeking to get what they need to change their circumstances.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
That can be online, in a mobile space, that can be through local community-based networks, but it's really a reminder that when our hospital and our larger systems fall short, communities will find ways to step up and get what they need.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I think it's a great idea. I mentioned I'm on the board of Neighborhood Birth Center here in Boston that is being spearheaded by our Shiro and the Shiro Burrell. And we are in a transfer agreement. We have a hospital here that's close to where we will be opening. And that's our transfer hospital. It's like a fire extinguisher. You only use it if you need it.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
The fire extinguisher is on the wall and you make sure that it's up to date and hasn't expired. But if your house is on fire, you're going to be very happy that you have one. That's the best way that I can think about this birth center hospital relationship for people who are considered low risk and have that ability and desire to deliver in a birth center. They should be able to do that.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And for people that need a little bit more intervention or something happens in the labor delivery process, if you don't have a transfer hospital, it could be a disastrous event. So I'm a huge proponent of birth centers. Obviously, I'm on the board of one. And I also think it's never a bad idea to have an agreement with the transfer hospital in case of those situations.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We don't pray for those, but you do want to be prepared if and when it does happen.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I think choosing the right midwife and birthing facility is like choosing any healthcare provider. You want to make sure their philosophy of care is in alignment with your values and what you need. I always tell expecting parents to be really clear about what is the midwife's credentials and the scope of practice. Is the midwife a certified professional midwife?
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Are they a certified nurse midwife or any other type of credentialed midwife? How many births do they do in a year at the birthing center? What is their natural birth success rate? What is the birthing center's facility's overall approach to pregnancy and childbirth? What does their tangible support look like during the prenatal period, the labor, and the postpartum periods?
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
How long have the midwives who practice there been in practice? What factors would lead to a transfer? Like what's their protocol for non-emergency or emergency transfers? What hospitals do they actually have these privileges with? There are some hospitals you don't want to deliver there. Do they work with OBs? What OBs are part of the board of birthing centers?
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Even on our board here at Neighborhood Work Center, we have a number of OBs who are on our board. We have midwives on our board. What is the model for that? And I think for expecting families and parents, you want to keep going until it feels right. I always advise interviewing multiple providers, getting a second and third opinion. You keep looking until you find the right fit.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So many things. The birthing process, being in labor, there's so much that happens in that time frame. It can be fast. It can be precipitous labor. It can be elongated labor. It could be a brief birth. There's so many things that are happening moment by moment. The best thing clinicians can do is to be present and attentive to the needs of their patients.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
It sounds very duh, but you have to be tuned in. You have to be attentive, make eye contact, check on your patients, respond to their requests, prioritize their needs, listen to them, listen to their family members. You will get a lot of information that can help to deliver better quality, more accurate care, that is congruent with their needs.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And when you have a better patient provider relationship, they'll tell you more. Hey, I'm having a headache. Oh, that could be preeclampsia. Oh, I just passed a large blood clot. Oh, that could be a hemorrhage. So that's one thing I would say is just to hold space for your patients and be available to them.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
That's the biggest thing that providers, nurses, anybody that's bedside, that's patient facing can do. All of us are human and clinicians are people just like anybody else. Yes, they went to school. Yes, they have highly specialized training and skills and certifications. There's so much bias and prejudice built into the way that they interact with patients. Do you introduce yourself?
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Do you acknowledge your family members in the room? Do you give a nod to the doula who's watching the situation play out? Do you check in with the birthing person? How are you feeling? How's your pain management? These are small things that clinicians and nurses who are bedside can do to really create an atmosphere of safety. And then obviously delivering the highest, best quality health care.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
If someone is experiencing blood loss, it could be a hemorrhage. We should consider it as such. It's just the delays in care. It's the wait and see. It's the we'll put in an order later. It's we'll look into this at another time. All these seemingly small occurrences in labor and delivery and postpartum can have life altering consequences. That's the interesting thing about this work. It's not.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
one person. It's not a policy. It's a system. The system is inherently broken and biased. Some people will say the system is operating quite fine for who it's designed to operate for, and I can agree with that as well, but it's just a dysfunctional system.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And I think our ability to penetrate that at different places through advocacy, training, building relationships with clinicians, centering lived experiences, honoring people's birthing requests, collaborating with doulas and midwives. That's really what we need to be doing. It's not one place we can target.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
It's this more multifaceted blanket approach that takes everybody tapping in at your level of need, your level of expertise, what's within your wheelhouse. All of that is necessary in this conversation.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I think the best thing for policymakers is to listen to their base. We have really powerful lived experience stories that we hear. We do a lot of advocacy here at my center, not only at the local level, but our state house where they're all the time supporting legislation that's being introduced. But also at the federal level, I think that's really where the rubber meets the road.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Are we able to talk to our elected officials that we put in office that work for us about what our needs are? I tell people all the time, advocacy is skill and it's an art, but anyone can do it. So if you're in a position to call your legislative office, I'm a constituency, I live in your zip code. Here are the issues I'm prioritizing.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
They have staffers that will take that call, that will make that note. They're public officials, they're public servants. So I think that's one way that I really implore people to get in the fight is through channeling your relationship with your elected officials and using advocacy for good.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I started a center here. It's the Center for Black Maternal Health and Reproductive Justice about three years ago. We're an academic-based, but community-facing research center that is focused on advocating for quality, equitable, and respectful care. And this is before, during, and after the pregnancy period. Some of our accomplishments are based in our six units of the center.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Good afternoon, everybody. My name is Dr. Mutana Kaga. I am the founder and director of the Center for Black Maternal Health and Reproductive Justice, as well as the founder and director of the Mother Lab, which is a large research lab dedicated to training the next generation of maternal health scholar activists. I have 35 students in that lab.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So we have the mother lab, which is our student-run, student-led research lab. that engages both current students in public health, social work, nursing, medicine, anthropology, law, economics, to really think about maternal health. And we do this through webinars, publishing research, advocacy, anything that can really amplify maternal health.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
One of the initiatives that the Mother Life students came up with, they're called Nurture Kids. We're partnered with a number of domestic violence shelters and women's centers in the area and donating postpartum kits and resources after their patient population delivers. We know that's an important entree into that parenting journey is the ability to support yourself during the postpartum period.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
There's no shortage of ideas or needs that the students have and that we have as a center. We also have a unit that focuses on data. How do we serve as a hub for research and put our finger on a pulse of where the opportunities for intervention lie? We analyze a lot of data.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We have epidemiologists or statisticians who can analyze disease trends and look at current data and say, OK, here are the places of intervention. And here's where we can subsequently support birthing people in the inter-pregnancy period. So if a person had a previous SMM event and we're looking at the data, we can say, OK, here's where the points of opportunity are to kind of interrupt that.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We also have a focus on policy, a focus on education and training, being very intentional about building a culturally responsive workforce. We work with students, practitioners, doulas, midwives, focusing on racial bias, cultural competency, and a very clear focus on patient-centered care. And then our community engaged research unit, which is our face of the center.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
focuses on building and maintaining partnerships with our community stakeholders, OBGYNs, public health leaders, doulas, other academics, community health workers, policymakers, to really co-create solutions that are going to reduce maternal health inequities. So the center is a small but mighty think tank.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We're very intentional about our ability to hold space for communities because ultimately that's where the answers lie. And we are researchers and scholars who have a passion for this, but we would not be, frankly, able to move our mission forward if we did not co-create it with other community partners who are able to assist us in this work. This is why the center is so unique.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Half of my lab is 19 years old because that's the next generation of scholars. They're 19 today and then tomorrow they're in medical school and then after that they're in law school and they're on the floor for L&D as a training as a nurse and they're on the ground doing public health programming. If you're not investing in the next generation, then what are we doing?
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Clinicians only focus on individual level treatment. Public health people, we focus on population level prevention, but we need each other. Clinicians don't have the training, a lot of them, to run large academic studies. And we as researchers don't have access to a patient population. We're not bedside. So herein lies the solution and the challenge.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I'm also a dean here in the School of Medicine and I have a consulting company. Thanks for having me.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
It's really just about breaking down our silos, checking your ego at the door, and working collaboratively to save lives.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
One of the things I want listeners to leave with is our goal here at the center is to strengthen our partnerships, deepen our commitments, work in service of maternal health with an urgency and an intention. And if listeners want to get involved in our efforts, we are a self-funded center. So we really rely on financial support to fund our research, to stipend our students, to provide trainings, to
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
support our advocacy efforts. So people are welcome to partner with us, whether that's through collaboration, shared research projects, or any other form of engagement. Partnership really does help us advance our mission of equitable maternal health care. We do an annual conference every year on Black maternal health.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So our ninth annual conference will be April 2026, which is focusing on the role of women's health in addressing maternal health inequities. That's a big financial endeavor, and we make it cost effective. We bring in the best speakers in the country.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
This year, April 4th and 5th, 2025, we brought in a number of Black male fathers and other leading experts who would either, one, are doing policy and advocacy work in that space, or two, had experienced the preventable loss of their partner during labor and delivery or postpartum complications. It's a really powerful conference, so that's an opportunity for engagement.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Another way is to sponsor a MotherLab student. MotherLab is addressing maternal health research and training the next generation of scholar activists. And these scholars are really, really ambitious. They want to go to conferences. They want to publish research. They want to do advocacy work. They want to work with community. All those things are expensive, and what keeps me up at night is
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Getting that email that inevitably will say, hey, Dr. Muta, I want to go to this amazing conference. I want to get a training. I want to get a certification. They're students. They're ambitious. They're hungry.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
As their mentor, I want to be able to support them because I know that these students are going to get that training through my lab and they're going to go on to do great things and save lives. We are small and scrappy, but we're committed. And I think everybody that works here has some type of personal tie to the work.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
A lot of my professional journey was shaped by personal tragedies. So I lost a friend of mine in childhood. She died from complications after giving birth. She had lupus and the pregnancy exacerbated her lupus. The hospital she delivered in was not equipped to handle a high-risk pregnancy.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Either they're a birthing person or one of their family members had something like everybody has skin in the game, which makes us work harder. There's so much need that if you're a researcher, we need you. If you're a fundraiser, great. If you have marketing, great. You have relationships, awesome. We need everything. I really do want to just implore people to reach out.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We're very, very, very willing, open, appreciative of all the support that we get. I know that our work is so successful because we have such strong relationships and partnerships. So we could always use more. All of our information is on our website, blackmaternalhealth.toughstudy.edu. We're on Instagram, CBMHRJ underscore Tufts. We also have a LinkedIn site.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We have Facebook or email, blackmaternalhealth.tufts.edu. In this current landscape, now more than ever, we do have to be creative in our fundraising efforts and our strategies and our resources.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Oh, you're so welcome. Thank you for this opportunity.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I think experiencing that as a young person, I was 16, she was 15, and then experiencing the death of a colleague and friend in my adulthood, Dr. Shalon Irving, who was also a preventable case, had been seen eight times after delivery, should have been readmitted and prioritized, was not. and also died from complications after her delivery.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
These types of events solidified my professional expertise and passion in Black maternal health. I also have training in this area. My doctorate is in maternal child health. I'm a woman with lived experience. I have children of my own, and I can firsthand see how the healthcare system does not prioritize and frankly fails to listen to Black women in the pregnancy and birthing process.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So that is both the personal and professional overview of how I came to do this work, addressing these systemic inequities and really questioning why do we see the disproportionate maternal mortality and morbidity around Black women.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I've been coupling that with the research aspect of it, so both quantitative and qualitative research, really trying to document how pervasive the impact of racism, environmental stressors, and unequal access to care is on Black women's bodies and birth outcomes. And then a lot of my work also includes authoring studies and being a principal investigator of research studies
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
where I'm able to either, one, contribute to the healthcare and clinical pieces of it, or two, we've developed curriculum and done a lot of advocacy work. Really, these are the reasons that I founded the Center for Black Maternal Health and Reproductive Justice, and also the reasons why the center does so much work to confront the disparities that we see for Black women and their families.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
The United States is in the middle of a maternal health crisis. It is one of the most dangerous high-income countries in the world in which to give birth. During the pandemic, we looked at our maternal mortality rates. It was 32.9 for every 100,000 live births. But for Black women, the rate is actually more than double, 69.9 deaths at its highest peak in 2021. That's abhorrent.
Something Was Wrong
S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So it's declined a little bit for Black women, but there's still a very large racial gap. We know that Black women are still two to three times more likely to die. from pregnancy-related causes in white women, the maternal health crisis is compounded by the fact that 84% of maternal deaths in this country are actually preventable.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So I think when you look at the data, you look at it by race, you look at an aggregate for all women, we are in the middle of a really bad place that will only get worse as we see structural racism, bias, systemic dismissal of Black women during the birthing process continue to exist.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And another thing I really want to be clear about is that these inequities for Black women persist even with Black women with a higher education or socioeconomic status. A Black woman with a college degree is still more likely to die from childbirth complications than a White woman with a high school diploma.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Black infants are more than twice as likely to die before their first birthday compared to White infants, so we still see a really tremendous gap in racial outcomes for infant mortality. Preterm birth, which is defined as a birth of an infant before 37 weeks of gestation, is 50% higher among Black women than White women, which also has a lot of implications for long-term gestation.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
care and long-term health outcomes for the infant. Black women are also more likely to experience severe maternal morbidity. So morbidity is illness, mortality is death. Even the things that are considered to be SMM events, severely maternal morbidity events, We still see higher rates in Black women. This is during childbirth, this is after childbirth, and these include hemorrhage.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
The majority of maternal deaths due to hemorrhage, 90% actually, are preventable. So are a lot of the complications we see from preeclampsia, which is hypertension and cardiomyopathy. Thinking about what it means for Black women, for all women, the maternal mortality rate for all women increases with age. And Black women are more likely to delay childbirth due to socioeconomic barriers.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
This disproportionately impacts age-related risks. We are in a really dire place. When you can say comfortably that 84% of maternal deaths are preventable, we're not just feeling Black moms, although we're feeling them even more, but we're feeling all birthing people, all mothers. No one is really faring particularly well in this current healthcare environment. These statistics are jarring.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
They should make us angry. These statistics individually and cumulatively really highlight the urgent need for systemic change in our country.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And this includes policy reforms, clinical accountabilities at the provider and hospital level, Medicaid expansion and the maintenance of Medicaid as a program overall, workforce diversification, having community-based models of care, thinking about the quality of healthcare that women in this country receive.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I think racism is the root cause of a lot of the disparities that we see. Racism defined structurally is not just one bad actor. It's a system that shapes maternal care that was not built to serve Black birthing people equitably. If we think about just the field of obstetrics and gynecology and how it was developed, it really was built on exploitation and dehumanization of Black women.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We know that a lot of the policies that Texas and other states are adopting are not in the best interest of birthing people as far as having hospitals closed, having to travel further to hospitals, having more difficulties with transportation, being able to access timely prenatal care.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We know that that increases the risk of people not being able to get to care, particularly if it's a high risk pregnancy. So this is just a bad series of events, policy decisions, racism, health care access, proximity to providers, lack of highly trained, skilled providers in rural parts of the state.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
All of those things cumulatively are why we're seeing the higher rates that we're seeing in Texas and other parts of the country.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
You touch on something that I just want to illuminate, which is the field of obstetrics and gynecology, how clinicians are trained. I think if you ask the average first or second year medical student, do you think people of color, Black people have thicker layers of skin, have higher pain thresholds, all these types of questions, they'll tell you yes, which we know is not accurate.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
But when they're being trained in racist ideologies, up until recently, the person that was considered the godfather of obstetrics and gynecology was an inhumane, racist criminal who essentially perfected his surgical techniques on the bodies of Black enslaved women without anesthesia, without consent. There were up to 12 women that he did these things to.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We only know three of their names, Lucy, Betsy, and Anarka. J. Ramsey perfected these techniques, how to repair fistula, how to perfect the C-section, how to create a speculum. All these techniques and procedures were perfected on the bodies of Black enslaved women with no pain medicine, no consent. This is the history of obstetrician gynecology in this country.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So clinicians who are trained in these racist ideologies will perpetuate them, particularly for clinicians who may not come from diverse communities, may not have a lot of overlap and interaction with people of color, may not be comfortable in those spaces, may have preconceived notions, may have racist and biased stereotypes, gender stereotypes.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
These things all exacerbate the ability to deliver information. quality and timely care to birthing people of color. You know, it's very problematic that these things exist. And frankly, if you talk to most OBGYNs today, they'll tell you that's the history, but all of us are not doing it now. Up until pretty recently, people thought J. Ram Sims was a There's an algorithm called the VBAC.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
So it essentially calculated the likelihood of someone being able to labor vaginally after having a prior C-section. And it subtracts from your likelihood of success if the person is a person of color. So this is not something that has any medical accuracy.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
It's literally putting in someone's race into an algorithm and then telling the patient, I think you're going to need another C-section, even though the person may not actually need that.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Thinking about the historical context of the discipline of obstetrics and gynecology, thinking about this VBAC algorithm, which up until quite recently was still in use by many obstetric practices around the country. These are racially based and racially motivated practices that have very dire implications for Black birthing people and other birthing people of color.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
There's no one isolating situation. It's the culmination of all these racist practices and tendencies that are now working together to unfortunately undermine the quality of care that Black women get and frankly impact their ability to safely birth in hospital settings. The field of midwifery also has its own problematic beginnings.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
First of all, the field of midwifery started because Black women were not able to deliver in hospitals that were considered to be white-led. And so in a lot of parts of the country, particularly in the South, we had our own models of care, and that was the granny midwives.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And these midwives were community leaders, traditional birthing attendants that really safely and successfully delivered infants for a long time. And then once I think we started to see the credentialing of the field, the certifying body started to pop up in midwifery, it became largely problematic For Black women, they were criminalized for doing things they'd done for years.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Supporting births in home settings, in birthing centers, now became a criminal offense. We know that the midwifery model is a successful one, but we know that this is problematic because just like the history of obstetrics and gynecology, Black women who were not prioritized in that space were pushed out and really a whole generation of midwives was seemingly obliterated.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Once we went to the credentialing process, you had to be a nurse midwife or you had to be some type of credentialed midwife. It removed a lot of the autonomy that Black midwives had had. The field of midwifery also became very whitewashed and very white-led. And I think that's where we lost a lot of it.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
The irony about this whole maternal health crisis is that by pushing Black midwives out of a discipline that we created when we were in need, Now we need more Black midwives. And so there's a whole push for getting more midwives back to the table and training more midwives and getting more midwives credentialed.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We would not have had to do that if it had not been usurped by white women and, frankly, the healthcare system. And finding another way to push Black people out of organically delivering safely and supporting births. We need more Black midwives because we know that when patients and providers are
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
are congruent, so you have a provider and a patient from the same racial background, there's better outcomes. This cycle is all predicated in racism. It's similar to what we saw in obstetrics. This is why we don't have a lot of OBGYNs of color.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We need a more diverse perinatal and maternal health care workforce, which includes doulas, midwives, nurses, OBGYNs, maternal fetal medicine, doctors, which is a specialized obstetric provider. We need more of them to be from communities of color, to be from underserved backgrounds, to be immigrants, have different language abilities and come from different backgrounds.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
We need all these people at the table because ultimately, when we are trying to figure out how to reduce unnecessary and completely preventable deaths, we need people that have lived experience in that space.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
I think it would.
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S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
And I think we also would have to do a really intentional targeted recruitment to make sure that while we are providing universal health care, which ideally should level the playing field for all birthing people, it should reduce bias, it should elevate the experience for everyone, make it more equitable across the playing field, that we're also making sure that we are intentionally not only recruiting from communities of color and prioritizing that, but we're able to